Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

prescription rejection from insurance

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mikeyb39:
Hi all,
My Dr. wrote me a prescription for Tramadol 100mg 2x/day.  I took it to CVS to get it filled and my insurance rejected it, stating that the dose was too high.  This sort of pissed me off since my 'DR' prescribed it for me

This is for the neuropathy in my feet that flares up from time to time.  Well long story short they have to play around with the insurance company by hoping to do the 50mg 3 to 4 times a day.

anyone ran into this.  I almost want to pay it out of pocked, its only 20 bucks versus the 5.00 with my insurance.  you just have to jump loops.

Jeff G:
Hi Mikey . I'm in pain management and my Blue RX wouldn't do 3 times a day dosing , so my doc had to write me a script for a lower dose and gave me twice the pill count to make up for it ... very odd but it works .

I now have 3 scripts each month to get filled . Its also getting harder to get pharmacy's to fill scripts for narcotics and you can forget getting them filled if you are out of town at refill time .   

mitch777:
A couple months ago I had to start taking Lunesta for insomnia issues.
My hubby had a few 3 mg pills left over.
I found they worked but thought I might be better on a lower dose. (too groggy in the morning)
Lunesta comes in three doses. 1,2, and 3 mg.
I asked my doc for a script for 1 mg written "take 1 or 2 tablets".
He had no problem with that.
The insurance company (BCBC) did.
Funny, they would cover a 30 pill supply of either 1 mg OR 2 mg even though 60 pills of 1 mg=30 pills of 2 mg.
Not sure why they would not want to give me the option of taking LESS medication.
(probably costs them more is my guess)
Sad.

Miss Philicia:
Sometimes when private insurance balks your doctor can make an appeal stating something is "medically necessary" -- if he's willing to jump through those hoops. Some doctors probably find simply adjusting the dosing/script as described easier than this other route.

mikeyb39:
Hi all
Thanks for the responses.  They ended up calling my doctor and he advised them to do the 50mg 2 twice a day as needed which upped the quantity to 120 tablets versus 60 count if could have stuck with 100mg tablet. Doesn't make since in the scheme of things,but doing the 50mg it went straight thru the insurance with no issue

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